The aftermath of 25 years of "urban renewal" in American cities
testifies to the enormous power of place in individual and social stability,
and to the profound psychosocial implications of displacement.
So said psychiatrist Mindy Thompson Fullilove, M.D., in a lecture at APA's
2006 annual meeting in Toronto.
The American experiment in urban renewal and the displacement of entire
neighborhoods in cities across the country carries profound lessons for how to
respond to the destruction of the Gulf region by Hurricane Katrina, she
"There is much to be done in the management of displacement, and
psychiatrists have a very fundamental role in the process," Fullilove
said. "For the suffering person who comes to us and needs our care, it
is essential to place the life story of this person who has suffered from
displacement in the larger context of where the person came from, why the
person was forced to move, and where the person might possibly go.
"Whatever symptoms [such people] present with may literally be the
symptoms of this rupture in their life pattern, and the most important thing
you can do is to reorient them to the task of living."
Regarding the reconstruction of the Gulf region in the aftermath of
Hurricane Katrina, Fullilove said psychiatrists can also play a part in
helping to generate political will to commit adequate resources—a
commitment that she said needs to be comparable in scale to the Marshall Plan
to rebuild Europe after the destruction of World War II.
"The failure to have a reasonable plan after Katrina is at the heart
of illness and destruction that are going to affect generations of
people," she said.
Fullilove is a research psychiatrist at the New York State Psychiatric
Institute and a professor of clinical psychiatry and public health at Columbia
University. She has conducted research on AIDS and other epidemics in poor
communities, with a special interest in the relationship between the collapse
of communities and decline in health.
She has published widely and has written two books, Root Shock: How
Tearing Up City Neighborhoods Hurts America and What We Can Do About It
(One World/Ballantine Publishers, 2004) and The House of Joshua:
Meditations on Family and Place (University of Nebraska Press, 1992 and
Fullilove's observations were drawn from her study of the aftereffects of
urban renewal, the effort from 1949 to 1973 to rebuild America's inner cities
by uprooting long-established, largely poor, predominantly African-American
communities. This effort was and is still widely regarded as"
progress," but Fullilove said it could more properly be described
as a form of ethnic cleansing.
During that period, 2,532 urban renewal projects were undertaken,
two-thirds of which were directed toward African-American neighborhoods at a
time when blacks were just 12 percent of the U.S. population; in this way,
African Americans had five times the risk of being affected by displacement
than should have been expected on the basis of population, she said.
"There was a great desire to get African Americans away from downtown
areas," Fullilove said. In the place of their indigenous, organic
neighborhoods were built office buildings, tourist attractions, cultural
institutions, and sports arenas.
As an example, she showed before and after photographs of the Hill
District, an African-American neighborhood in Pittsburgh that was uprooted to
make room for, among other buildings, the Mellon Arena, home to the Pittsburgh
Penguins hockey team.
"There is a real clash of who wants the land for what," she
said. "This is a fundamental clash in all episodes of displacement.
Whoever has the power to write the history of displacement will say that
whoever used to have the land used it badly and that they will use it well.
There is no narrative of displacement that does not contain this story
Yet these same neighborhoods were home to a rich culture and a crucial web
of family and communal relationships that have been irrevocably lost.
Fullilove illustrated her remarks with photographs taken by Charles"
Teenie" Harris, an African-American photographer who left behind
a remarkable photographic record of everyday life in the Hill District:
dances, parades, checkers games, customers in a barbershop, and casual
neighborhood gatherings on sidewalk stoops.
It was in African-American neighborhoods like the Hill District that jazz
music also flourished. This distinctively American music was nearly lost along
with the rest of the cultural heritage of uprooted neighborhoods, only to be
preserved by aficionados in Japan and Europe. "In this way it became a
very cerebral music, divorced from the folk culture of the ghetto,"
Fullilove said. "It became a different kind of music, not the music of
the community, but the music of music lovers."
She likened the psychological devastation of losing one's home in this way
to "root shock," the trauma suffered by plants that are uprooted
from the soil that nurtures them.
"If your home was here," she said, "you can never go home
again. There are people from the Hill District whose homes were in what is now
the middle of the ice at Mellon Arena. They have a feeling about where their
home is, but they can never go there."
Beyond the losses—financial and psychological—of the displaced
populations, Fullilove emphasized that the uprooting of communal relationships
has a profound impact on the larger
Mindy Thompson Fullilove, M.D.: "The failure to have a reasonable
plan after Katrina is at the heart of illness and destruction that are going
to affect generations of people."
She drew on the work of sociologist Mark Granovetter's 1973 article"
The Strength of Weak Ties" to illustrate how individuals are
typically bound by both "strong ties"—those of race,
religion, or tribe—and "weak ties," relationships with
individuals forged in the day-to-day course of living: the barber, the
waitress at the coffeeshop, the cashier at the grocery story.
She noted that when people lose the web of relationships that comprise
their weak ties, they fall back on the strong— and potentially socially
divisive—ties of race, religion, and tribe.
"It was precisely these weak ties that were severed in the uprooting
of neighborhoods," Fullilove said. "Those weak ties are the
relationships that get people jobs and that link them to the political system.
They spread across ethnic groups, and when those cementing relationships are
broken, the emergence of tribal hostility and factionalism after displacement
is absolutely to be expected."
She also cited the work of social psychiatrist Alexander Leighton, M.D., to
stress that as social bonds are ruptured, the overall social organization
changes. It was Leighton who posited two theoretical extremes—the model
supportive community and the loose collection of individuals—and said
that as a society moved along the continuum away from the model toward the
loose collection, it could expect to see more and more mental illness.
As the weak ties that bind individuals to one another have been ruptured,
Fullilove said, American society has moved more and more toward the extreme of
the loose collection of individuals. She added that Leighton pointed out 50
years ago that status and wealth do not protect individuals in a society that
is moving toward a mere collection of individuals.
"The well-to-do in a collection have worse health than the poor do in
a model supportive community," she said.
Fullilove noted that recent research appears to bear out this dismal
prediction, citing a report in the May 3 Journal of the American Medical
Association (JAMA) showing that middle-aged white people in America have
worse health overall than white people of the same age in England, despite
much higher health care spending here.
In the categories of diabetes, blood pressure, and cancer, England's
poorest citizens—those in the lowest one-third of income
levels—did better than the richest one-third of Americans.
Importantly, as the state of social organization changes, individuals
within the society adopt new, more aggressive behaviors to fend for
themselves. She cited Geoffrey Canada's 1996 book Fist, Stick, Knife,
Gun, which showed the downward spiral of urban violence from fistfighting
"The change in the state of organization has made the gun not
optional," she said. "In a state where everyone has a gun,
everyone has to have a gun. The tragic part of this decline in social
relationships is that it takes much more aggressive behavior to take care of
yourself. In a well-organized community, there are established ways of
sharing. In a disintegrated community, you have to fight with someone
An abstract of "Disease and Disadvantage in the United States
and England" is posted at<http://jama.ama-assn.org/cgi/content/abstract/295/17/2037>.▪